Generalized anxiety disorder (GAD) is characterized by persistent, excessive worry. To confirm a GAD diagnosis, it must persist for over half a year, be present much of the time, and on most days. Those affected frequently express concern about apprehensiveness and/or irritability. Anxious elderly people commonly suffer distress, functional impairment, and somatic complaints, like fatigue or muscular tension. Serious medical pathologies often coexist, complicating lives with disabilities, and making clinical interventions complicated. Patients and physicians often find anxiety difficult to cope with or control.

Generalized anxiety disorder is the most common anxiety disorder among people over age 65 years (1). Phobic and/or panic disorders are occasional co-occurrences (2). Depression, substance abuse, and posttraumatic stress disorder are other co-morbidities.

Fear of falling down is a major concern among some of older individuals (4). Half of those who fell in the previous year exhibit persistent fear of reoccurrence (5). Women, people with impaired mobility, or those needing gait assistance devices are particularly prone to such concerns. In this population, falling is commonly associated with significant injury, even death. Because of osteoporosis, women are particularly at risk for bone fractures and associated trauma-induced pathologies (e.g., pulmonary emboli). That can result in protracted fear of falling, further immobility, and isolation.Gait precautions become paramount among infirm elderly people (6).

Social phobia is characterized by those who feel excessively watched in social situations. Fear of public speaking is one example.

Specific phobias are magnified fear responses to a specific object or situation; apprehension about falling can become a phobia. Since impaired balance and falls are so problematic, this might also be protective (4). Nevertheless, about half of all older residents in long-term care facilities are unstable while walking (7).

Newly diagnosed patients with mild anxiety sometimes undergo psychotherapy, such as with cognitive-behavior therapy (CBT). If symptoms are more profound, talk therapy is often combined with pharmacotherapies.

Benzodiazepine medicines can be prescribed to quickly diminish emotional and somatic anxiety symptoms. If urgently needed, they are especially indicated only early in treatment, before other initial therapies achieve efficacy. Because these drugs induce tolerance, addiction, and potential misuse, they are not indicated for patients with substance abuse risk factors nor whenever misuse occurs. The development of pharmaceutical tolerance is a big concern; others include impairment in memory, gait, or dexterity. Benzodiazepines, thus, are often recommended only for short-term applications, aiming to avoid dependence, rebound insomnia, cognitive decline, and/or gait instability (9).

Pharmacotherapies in general, polypharmacy in particular, and high medicinal dosages are associated with more risk of falling. This is especially true for patients with dementia and/or with other infirmities (10). Yet, psychotherapy and/or medications can deliver greater personal comfort.